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Breast reconstruction can be a complex decision. Fortunately, women today have many options to restore their breast shape —including those offered by the Natrelle™ Collection. This section is meant to provide you with all the information you need to decide when, or even if, you want to pursue a breast reconstruction procedure.
The decision to undergo reconstructive breast surgery is a deeply personal and often difficult choice to make. Every woman makes her own journey back to health and wholeness… and no two experiences are exactly the same. For many women, undergoing breast reconstruction is an important part of embracing their health and moving into the future with confidence.
There are various ways to reconstruct the breast: a lot depends on a woman’s individual anatomy and preferences. Your surgeon will work with you to get a full understanding of all of the details that will guide the planning of your reconstructive procedure… details such as your health, the shape and size of your breasts, your remaining skin and tissue, and your desires and lifestyle.
The timing of reconstructive breast surgery
Breast reconstruction may be carried out in the same operation as the breast cancer surgery (it is then said to be immediate) or at a later stage, weeks or even years afterwards.
Whichever method of reconstruction is used, it may involve various steps before the final result is achieved. Chemotherapy or radiotherapy might also have an influence on the timing of certain surgical procedures and should be taken into consideration.
Depending on your situation, your surgeon may identify immediate breast reconstruction as one of your options. One advantage of this method is that when you wake up from the anaesthesia, you will already have moved partway down the reconstruction path.
While this may mean a slightly longer operation initially, it allows you to avoid the experience of having only one breast, or none if a mastectomy was performed on both breasts. However, you should be aware that the appearance of your breast or breasts might have been altered following your breast surgery and that the final result of your reconstruction might not be achieved at this stage.
Breast reconstruction at a later stage
If the decision is to opt for breast reconstruction at a later stage, often called ‘delayed reconstruction’, you will have the advantage of more time to make a decision. In fact, you can work on your recovery in two phases. You can begin by concentrating entirely on any follow-up treatment that may be required, such as radiotherapy, chemotherapy, or both. You will also need time to cope with the whole course of the disease, a process that may require a great deal of energy. On the other hand, delayed reconstruction means that you will have to wait for the restoration/return of your bodily contours for weeks or even months.
Breast reconstruction options
There are various ways to reconstruct the breast. Your surgeon will help you choose the best option based on your specific needs. Breast reconstruction can be carried out with the aid of a breast implant, by using your own tissue, or by a combination of the two.
Reconstruction with a breast implant
With this method, a breast implant is placed under the chest muscles to create a cover for the implant. In many cases, stretching the skin on your chest with an inflatable expander is necessary before placement of the final implant in order to recreate a natural-looking breast.
Breast reconstruction with your own tissue
With this method the surgeon may use your own fat, skin, and muscle tissue, most frequently from your back or abdomen. In a few cases, tissue can also be taken from your buttocks, your thigh, or even other distant regions of your body.
Breast reconstruction with your own tissue and a breast implant
In some cases, a combination of both techniques may be used, for example if you are very slim and have a large breast, the reconstruction may require both an implant and your own tissue to obtain satisfactory results.
Remember, your surgeon is the best person to guide you in making the right choice for your needs.
During your procedure
Depending on how you healed and how much breast tissue and skin is available to facilitate your breast reconstruction, your surgeon may decide that carrying out the breast reconstruction in several stages with an implant is the best option for you.
For women with less breast tissue and skin, the first stage of breast reconstruction surgery is inserting a tissue expander to help stretch out the skin and tissue to accommodate the breast implant. An expander is an inflatable silicone balloon-type device that is gradually filled with a saline (salt-water) solution, thereby stretching the skin, similar to what occurs naturally to your abdominal skin during pregnancy. This creates the room needed for the permanent implant to be inserted. Some months later, the expander is surgically replaced by the breast implant itself. If you have ample breast tissue to cover the implant and healthy, supple skin coverage, your doctor may surgically insert a breast implant without the need to stretch your skin with an expander first.
Stage 1. Insertion of the Tissue Expander
The expander is usually inserted behind the greater pectoralis muscle and is then regularly filled with a saline solution through a valve called a ‘port’. This port is an integral part of the expander itself. Filling is done with a fine needle, directly through the skin and is usually painless. Some patients may experience a slight feeling of tightness in the breast, but usually this quickly passes. With the aid of this procedure, the skin is gradually stretched.
While the regular filling of the expander does not involve much physical stress, it does make demands on your time and involves two operations. You should also be aware that some tissue expanders contain materials which are not compatible with MRI (magnetic resonance imaging). Please discuss this with your surgeon should you have any concern.
Stage 2. Insertion of Implant
Approximately 6 months after the first operation, when optimum skin expansion has been achieved, the tissue expander can be replaced by the permanent implant. Depending on your overall breast health and treatment plan, the time between the first and second surgery may be prolonged significantly by follow-up therapy. The surgeon will help you to choose the permanent implant to match your desires and remaining breast. In addition, you may be offered surgical adjustment to your remaining healthy breast to achieve the best outcome.
Breast reconstruction surgery is usually performed under general anesthesia. All anesthetics carry a risk, so you should discuss these risks with the anesthetist. The surgery usually lasts between 1 and 2 hours.
The procedure to insert the new breast implant involves creating a pocket for the implant. After the pocket is created, the breast implant is placed either partially under the pectoralis major muscle (submuscular) or on top of the muscle and under the glands (subglandular). Once the implant is placed, the incision is closed with stitches. In addition to stitches, it may also be taped.
For some women, the option of an expandable breast implant, which combines the functions of both the expander and the breast implant, is also available, and requires only one operation. This implant is composed of two parts: one part is filled with a saline solution, the other with silicone gel. This implant will act as both the expander and the permanent implant: In this case the port is located under the skin and is attached to the expandable implant via a length of tubing. When the right breast size has been achieved (by the addition of the saline solution), the implant does not need to be removed.
Stage 3. Nipple and Areola Reconstruction
In a mastectomy, the nipple is removed if there is any possibility that is may contain cancer cells.
Once your initial reconstruction procedure is complete, the reconstruction of the nipple and areola of your breast may be performed as a separate surgery.
The nipple can be reconstructed in any of the following ways:
- By raising the skin of the reconstructed breast, to create a little ‘button’
- With the aid of skin from the nipple on the other breast, provided that it is big enough
- By using a section of skin from the thigh, ear, or toe
- By inserting a piece of cartilage from the ear or rib under a small skin flap.
The areola (the darker skin around the nipple) can usually be reconstructed by tattooing, or, on occasion, with the aid of a section of skin from the groin or labia, since the skin is somewhat darker in these areas and resembles that of the areola.
In each case, the operation involved is minor and relatively painless. Operations to reconstruct the nipple and areola are carried out only when breast reconstruction has been completed. An important point to note is that reconstructed nipples usually have no sensation.
After your procedure
In general, you can expect to leave hospital about 24 to 48 hours after your breast reconstruction surgery. In some cases, reconstructions require a surgical drain to remove excess fluids from the area that was operated upon. These are typically removed within the first week or two after surgery. Most stitches are removed after about 14 days.
You’ll need someone to take you home after each operation, as you won’t be able to drive. Initially, your breasts may be firm and swollen. You may have some dressings around your breasts and a surgical bra or elastic bandage depending on your surgeon’s preference.
There are several things you need to do and keep in mind after the reconstruction of your breast has been completed. First of all, you should consult your surgeon about the need for a medical follow-up or any complications or adverse effects of the implant or flap surgery and for further instructions concerning the first months after breast reconstruction.
You need to inform your physician or surgeon of the presence of an implant or flap in case that any type of surgical or diagnostic procedure of the breast area is planned. You should also consult your surgeon or the pharmacist before the use of topical medicines (e.g. steroids) in the breast area. Most importantly, you should consult a physician if you suspect any complication, especially in case of a trauma or compression of the breast caused, for example, by extreme massaging, by some sporting activities or by a seat belt during an accident. It is recommended that you carry your patient card/implant card with you at all times to facilitate medical care in case of an emergency (e.g. a traffic accident).
Breast Cancer & Mammography
You need to continue to consult a physician to carry out normal checks in order to detect possible recurrences of breast cancer. If a mammography is scheduled, you need to inform the radiologist (the doctor reviewing the x-rays) in order to adapt the mammographic procedure. This is necessary, because the presence of an implant or flap can influence the result of mammography and other diagnostic techniques. Even self examination/manual examination of the breast, which you should carry out on a regular basis, is more difficult after breast reconstruction.
If you have a breast implant, mammography might be more difficult to evaluate, because the implant shows up on the X-ray as a dense shadow. It is important that you inform the radiographer (person taking the x-rays) that you have breast implants before mammography as special techniques will need to be used to get the best possible views of the breast tissue. Nevertheless, several studies demonstrated that women with breast implants had no increased risk of breast cancer being discovered at later stages than other women.
Breast reconstruction may significantly impact on your ability to breastfeed. Please ask your surgeon for more information.
Feeling and Sensation
While reconstructive surgery can’t restore normal sensation lost during mastectomy, some feeling may return over time. Most scars from reconstruction surgery may fade considerably following your surgery, traces of the original procedure may remain visible.
Your breast implant/expander operation may take between 1 and 2 hours and will be carried out under a general anesthesia. The anesthesia may make you feel quite tired; however, it is usual to be out of bed later the same day and to be discharged home on the following day.
You will have a dressing on your new breast, the type will vary depending upon your surgeon and operation, as will the need to have it changed and removed. You may also have drainage tubes at the site of your operation. These are positioned to drain off any excess blood or fluid and will be removed after a few days.
It is likely that you will feel sore and have some pain following your operation. Your surgeon may prescribe pain medication to manage this pain.
Your surgeon or breast care nurse will advise you on the type of bra to wear to support your new breast following the operation. They can also guide you on how to approach stretching, bending, and lifting during the healing process.
It is important to look out for the signs of infection. Contact your surgeon or breast care nurse immediately if you notice your breast becoming red, excessively swollen, hot to the touch or if you feel feverish. You could also experience a build up of fluid in the area. Small amounts of fluid may resolve on its own, but larger amounts may need to be addressed by your surgeon in clinic.
Applying moisturizing cream to the area may improve the healing process and the condition of the skin. Please consult with your surgeon or breast care nurse about this.